Derm Clinical stuff (Darrow) - SRS Flashcards
Ident each of these eczematoid dermatitises.
- atopic dermatitis
- contact
- stasis
Type of dermatitis?
Vesicular dermatitis - herpes zoster
Type of dermatitis
Bullous dermatitis
A 45 y/o male presents with rectal bleeding due to rectal adenocarcinoma. He is examined and the following is seen. He reports that two years ago he had only a few of the skin lesions.
These are?
What is this sign?
seborrheic keratosis
sign of leser trulat - indicates multiple malignancies likely
A pregnant 36 y/o female presents with nausea and vomiting. Lab tests are normal except for an elevated alkaline phosphatase. Skin exam shows the following. This patient most likely has metastasis to the?
Liver
This 15 y/o female with “the itch that rashes” is most prone to what infection?
What is this disease process d/t?
- Staphylococcus
- IgE mediated
Staph biofilms can block sweat glands, what protein is involved in the innate immune system that is activated in areas where blocked sweat ducts arise in eczema?
Toll like receptor 2
An 8 year old child has a history of staphylococcal abscesses, a prior episode of pneumonia with pneumatoceles, high IgE levels,
eosinophilia, and rash as shown. He has lost none of his teeth. The primary problem in this patient is?
Job syndrome (Hyper IgE)
phagocytic attraction - phagocytes are working but not getting there. IL-8 is defective.
What are three examples of phagocytic dysfunctions (would see delayed umbilica seperation)
- “Not enough” (neutropenia)
- “Can’t get there” [LAD - no integrin CD11/CD18 - high WBCs –
recurrent bacterial infections, Hyper IgE (Job’s)–decreased IL8/
NCF]
3.“There, but don’t function” (abscesses everywhere) (CGD/NBT
test; G6PDD; Chediak Higashi/giant granules in WBCs and
platelets)
What are 5 examples of combined B and T cell immunodeficiency disorders?
- Ataxia telangiectasia (Louis-Bar)
- Wiskott Aldrich (thrombocytopenia and eczema)
- SCID (Alymphocytosis or Glanzmann – Riniker Syndrome)
- Nezelof’s syndrome (thymic dysplasia with normal globulins)
- Graft versus host disease
Wiskott-Aldrich has eczema with a combined what?
Immunodeficiency
Job syndrome has eczema plus what?
A neutrophil problem
A 40 y/o male presents with a pruritic left ankle rash which has been present for two years. Remainder of his exam is normal. This is?
lichen simplex chronicus
This 60 y/o male complains of dry itching skin with these lesions found in the winter. He bathes nightly. This is which eczema.
A.Nummular
(coin shaped lesions)
What are the two common locations for lichen simplex chronicus?
T4
Ankles
What probably caused the “flare up” in this case?
A.Stopping steroids
B.Trip to Florida
C.Lack of sun tan oil
D.Staph infection
E.Jelly fish stings
“I want you to know this”
Stopping steroids
What are two things that can lead to a psoriasis flare up like this?
- HIV (flare up may be a marker)
- Steroid withdrawal
Other things - beta blockers, lithium, interferon
This disease is associated with MI, ASHD, metabolic
syndrome, NAFLD, IBD, and depression. What is not
associated with this rash?
A. + ASOT
B. “Herald patch”
C. Arthritis
D. Koebner’s reaction
E. Nail pits
B. “Herald patch”
This is psoriasis
What organism is associated with psoriasis flare ups?
Streptococcal infections
This patient has arthritis with:
A.ankylosing spondylitis.
B.sarcoid.
C.Lyme disease.
D.nummular eczema
E.psoriasis.
Psoriasis
Assuming these patient’s have the same condition, what is the diagnosis?
A. Psoriasis
B. Onychomycosis
C. Lichen planus
D. Candidiasis
E. SLE
Psoriasis
These patients should be tested with:
A.serum assay.
B.culture.
C.KOH prep.
D.Tzanck test.
E.NBT.
KOH prep - for fungus
KOH prep reveals mycelium. Infection at the sites pictured here may also be termed tinea faciei.
What are three common pathogens?
Where do the fungi lodge?
- T. tonsurans,
- T. rubrum,
- T. mentagrophytes
- Fungi lodge in the stratum corneum.
This patient has trichophyton rubrum and also has:
A. psoriasis.
B. alopecia.
C. paronychia.
D. eczema.
E. AIDS
Aids
This truncal rash produced a dull yellow fluorescence under wood’s light. The patient’s rash became more prominent with sun tanning. This is:
A. Cornyebacterium.
B. Malassezia.
C. Proprionobacterium.
D. acanthosis.
E. erythema ab igne.
Malassezia furfur
How might malassezia furfur be described?
spaghetti and meatballs
What does tinea versicolor worsen with?
What organism is associated with this?
Tinea versicolor = worsens with Cushings, malnutrition or immunosuppression
M. Furfur
This 20 year old woman has been using what on her face?
A.Steroids
B.Vitamin A
C.Tetracycline
D.Metronidazole
E.Hydrogen peroxide
Steroids - malassezia folliculitis
This rash shows pink fluorescence under Wood’s
light. This is:
A. Tinea
B. Trichophyton
C. Corynebacterium
D. Aspergillus
E. Pityrosporum
C. Corynebacterium
Wood’s light is fluorescent lamp emitting “long wave” ultraviolet A. Certain infections fluoresce on exposure to the light. What are they?
- Bacterial infection in skin flexures due to erythrasma (Corynebacterium minutissimum) fluoresces coral-pink.
- Pityriasis versicolor fluoresces yellow (Malassezia).
- Cat ringworm Microsporum canis fluoresces green.
This 65 y/o patient with preexisting psoriasis will most likely be in need of:
A.Antibiotics.
B.Fluids.
C.Surgery.
D.B12.
E.OMT.
Exfoliative dermatitis - must replace fluids since loss d/t weeping is significant
This woman is on BCPs, has hepatitis C and an elevated ALT. The man complains of increased temporal hair growth and has been exposed to polychlorinated aromatic hydrocarbons. What do they have?
A. HUD deficiency
B. Low hepatic iron
C. High ACE levels
D. Diabetes
E. Congenital disease
HUD deficiency - hepatic uroporphyrinogen decarboxylase (UROD is what everyone else calls it)- porphyria cutanea tarda
Test question
How would you dx porphyria cutanea tarda?
- Fluorescence of urine with a Wood light examination.
- caterpillar bodies
This patient is suffering from a bilateral pneumonia with bullous myringitis and a dry cough. He has:
A. Herpes.
B. Mycoplasma.
C. Coxsackie virus.
D. pemphigus.
E. Rickettsia.
B. Mycoplasma. - frequent cause of erythema multiforma
This woman was placed on piroxicam 3 weeks ago. She has 20% of her body involved with erythema and targetoid lesions. Her dermatitis was preceeded by fever, chills, headache and GI upset. Labs show anemia and neutropenia. Which is most likely present?
A. Erythema Multiforme
B. Kawasaki’s disease
C. SJS/Toxic Epidermal Necrolysis
D. Systemic Lupus Erythematosis.
E. Staphylococcal Scalded Skin Syndrome
C. SJS/Toxic Epidermal Necrolysis
Stevens johnson syndrome
What are SJS and TEN almost invariably d/t?
Drugs
What drugs cause SJS and TEN?
West (caucasians): 1. oxicam NSAIDs, ie perioxicam (Feldene)
- sulfas
East (asians): 1. carbamazepine (Tegretol) – HLA - B*1502
- allopurinol – HLA - B*5801
These seizure patient have over 30% of the body involved with fever, conjunctivitis, pharyngitis, GI ulcers, tracheal erosions, pancytopenia and sepsis. They have:
A. SSSS.
B. erythema multiforme.
C. pemphigoid.
D. TEN.
E. Kawasaki’s disease.
D. TEN.
If over 30% then is it TEN or SJS?
TEN
These patients most likely have:
A. Erythemia rhusiopathiae
B. Erythema marginatum
C. Erythrasma
D. St Anthony’s fire
E. Erythema ab Igne
D. St Anthony’s fire - erysipilus to everyone else
Which organism presenting as below is associated with colon, gyn, or lymphoreticular malignancies.
A.Streptococcus
B.Clostridium septicum
C. Anareobes
D. Enterococcus
E. E coli
B.Clostridium septicum
This patient spent the preceding day in a spa. Today she has which folliculitis?
A.Traumatic
B. Pityrosporum
C. Eosinophilic
D. Pseudomonal
E. Staphylococcal
pseudomonal
What causes eosinophilic folliculitis?
HIV
This inmate complained of a “spider bite” which occurred two weeks ago. He works as a tattoo artist. He most likely has:
A.Pneumococcus.
B. Bacillus anthracu.s
C. MRSA.
D. E coli.
E. Camplobacter.
C. MRSA.
This child may be in danger of:
A.Glomerulonephritis.
B.Hepatitis C.
C.coronary artery aneurysms.
D.Rye’s syndrome.
E.Encephalitis.
A.Glomerulonephritis.
This disease is characterized by the presence of:
A.telangiectasia
B.comedones
C.flushing
D.malar rash
E.rhinophyma
B.comedones
Which of the following is involved in acne?
A.Corynebacterium diptheriae
B.Corynebacterium minutissimum
C.Propionibacterium acnes
D.Acintobacter baumanni
E.Arcanobacterium haemolyticum
C.Propionibacterium acnes
What is the conjectured cause of this condition?
A. Demodex mite (Bacillus olernius)
B. Corynebacterium
C. Pityrosporum
D. Borrelia
E. Tinea
Many have SIBO* and
respond to rifaximin.
A. Demodex mite (Bacillus olernius carried on the mite)
This is rosacea
This patient has a tremor and was asked to smile. The cause of this rash is:
A.Monilia.
B.Malassezia furfur*
C.Coxsackie A16.
D.Streptococcus.
E.Staphylococcus.
B.Malassezia furfur*
Likes to grow on parkinsons patients
These painless, mucoid, grey white, broad based condylomas are
most compatible with:
A. Veneral warts
B. Verruca vulgaris
C. Syphilis
D. Herpes
E. HPV
●
HPV
This man spends a lot of time in the woods with ioxides scapularis.
What might this patient develop in the near future?
- A. Bell’s palsy
- B. Renal cancer
- C. Thrombocytopenia
- D Streptococcus
- E. Urethritis
•A. Bell’s palsy
What are the stages of lyme disease?
Stage I: Flu syndrome with rash (ECM)
Stage II: Dissemination: heart, joints, nerves and skin (heart block, Bell’s palsy, migratory arthralgias, ECM)
Stage III: Late: joints and CNS and PNS (oligoarthritis, encephalitis/memory loss - sleep disturbances, neuropathies/paresthesias)
Be aware of Southern Tick-associated rash illness (STARI)-Borrelia lonestari
